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Dentists raise fees, might exit family practices as pandemic keeps patients away

If patient volume stays as it is for a few more months, more dentists say they’ll look at raising fees, cutting jobs or selling their practices, the American Dental Association says.

While 99% of dentists have reopened since the spring shutdowns, the number of patients visiting offices remains about 20% below usual levels, according to the American Dental Association.
While 99% of dentists have reopened since the spring shutdowns, the number of patients visiting offices remains about 20% below usual levels, according to the American Dental Association.

Millions of Americans are delaying dental appointments over concerns about coronavirus infection, and that’s likely to continue to trigger higher fees for patients, job cuts for workers and fewer family practices.

When the pandemic began, essentially all dentists temporarily shut down for all but emergency appointments. While 99% of dentists have reopened, the number of patients visiting offices remains about 20% below usual, according to the American Dental Association.

And dentists don’t expect things to improve much more anytime soon despite significant safety measures they’ve rolled out to protect themselves and patients from COVID-19.

Spending on dental care could fall by up to 38% in 2020 and 20% in 2021, the ADA projects. Of dentists surveyed by the trade group, more than 46% said patient volume was down at least 15% during the week of Oct. 5.

About 15% to 20% of regular dental patients say “they’re not going to go back to the dentist until there’s a vaccine or a proven treatment,” said Marko Vujicic, chief economist of the ADA. “They’re waiting for COVID to pass, so to speak.”

Katia Lee, a self-employed professional photographer in Columbia, South Carolina, hasn’t gone to the dentist since before the pandemic. She doesn’t want to risk getting infected and passing it to her 76-year-old mother.

“I really like my dentist and my dental hygienist,” she said. “But I know at least half of them have families. That means you’re trusting not just them but their kids, their husbands — that’s why it’s so scary. I have to trust everybody else to keep myself safe.”

In August, the World Health Organization angered dentists by advising that “routine nonessential oral health care — which usually includes oral health checkups, dental cleanings and preventive care — be delayed until there has been sufficient reduction in COVID-19 transmission rates from community transmission to cluster cases or according to official recommendations at national, sub-national or local level.”

The ADA “respectfully yet strongly disagrees,” pointing to safety measures dentists have set up to reduce the risk of transmission, steps advised by the Centers for Disease Control and Prevention.

Those measures include heightened use of personal protective equipment such as N95 masks and surgical masks, disposable gowns, air purifiers, cleaning solutions, temperature checks, hand-washing and social distancing, some of them having patients wait in their cars until their appointment is ready to begin.

Dental industry leaders have said they’re not aware of any documented cases of COVID-19 outbreaks stemming from dental offices, but they know patients remain concerned about opening their mouths wide in the presence of others for extended periods of time.

If patient volume remains at current levels for a few more months, more dentists say they’ll consider — as some already have done — raising fees, cutting jobs or selling their practices, according to the ADA.

Lee said that even if it’s safe to go back, it’ll be hard for her to justify going to the dentist since she doesn’t have dental insurance.

People’s hesitation to go back has led dentists to seek help. When they temporarily shut down, about nine of 10 dentists applied for some form of financial assistance from the federal government, including forgivable loans, and the “vast majority” received some, according to the ADA.

But they’re still hurting. The ADA estimates the average dentist is spending an extra $15 to $20 per patient due to measures related to COVID-19 prevention. Some are passing those costs along to patients.

Dentists are unable to see as many patients as normal due to the time they need to devote to cleaning and spacing out patients to ensure they don’t come into contact with each other.

Family dental practices are struggling the most since they are unable to spread out the costs of PPE. Industry leaders and analysts say dentists are increasingly likely to sell their family practices to private equity companies or other investors.

Scott Asnis, a dentist and founder and CEO of Dental365, a network of dentists based in New York, has more than 50 locations and said he’s being flooded with inquiries from dentists about joining his network.

“I’ve never had more dentists reach out to me than I have since June,” Asnis said.

The move toward group practices and private equity ownership already was underway before the pandemic. Younger dentists with a lot of student debt often aren’t as interested in taking on the financial burden of launching their own practices.

One increasingly popular option is for dentists to join dental support organizations, which provide support for tasks like human resources and billing.

As anyone who’s ever had a cavity will know, the longer you put off an appointment, the worse it gets. Which is one reason dentists have reported an uptick in patient volume in recent months.

But there is lingering concern about what will happen once they’ve satisfied that demand.

One option for dentists might be getting involved in distributing coronavirus vaccines.

Also, dentists increasingly are looking for new revenue opportunities — like providing clear, removable plastic aligners, a braces alternative.